Summary Care Record The National Picture Dr Gillian Braunold Clinical Director SCR & HealthSpace March 2010 Gillian.braunold@nhs.net Understanding the record The clinical encounter record Detailed Care Record (local) Detailed Care Record (Shared) Including Pathways of Care Summary Care Record HealthSpace
What is SCR? Content of the SCR: The SCR is an electronic summary of key health information. It will hold limited essential information derived initially from the patients GP record, this will include medication, adverse reactions and allergies and a patients significant medical history. This will then be added to over time with content such as hospital discharge notes. What is SCR? Principles of the SCR: It will remain a Summary Record It will only contain significant aspects of a person s care Key items of the person s care will be added as time goes by It will be derived from the records of organisations delivering care to that person It will be initially populated by contribution from General Practice Patients will be able to see the record via HealthSpace A patient will be asked before their record is accessed, except in certain circumstances
The patient case for SCR What about all the controversy? Can patients refuse to have a summary? Yes! Can patients change their minds at any stage? Yes! Can patients limit what is shared? Yes! ( except core data set from GP)
Ensuring confidentiality and access N3 network Smartcards/Role Based Access Control (RBAC) Legitimate Relationships Audit and alerts Professional and contractual controls Professional and contractual controls Clooney and girlfriend Sarah Larson were injured in road accident Clooney hospital punishes staff Hospital workers in New Jersey have been suspended for allegedly looking at Hollywood star George Clooney's confidential medical records. The actor was admitted to the Palisades Medical Center last month after breaking a rib in a motorcycle crash. The 27 staff were suspended for four weeks without pay, for improperly accessing his records. Mr Clooney, 46, said he had only learnt of the situation this week, and hoped the matter could be resolved. "We believe this is a harsh penalty and an overreaction," said Jeanne Oterson, a spokeswoman for the Health Professionals and Allied Employees union.
Overcoming the Challenges Key stakeholders Adastra MPS www.connectingforhealth.nhs.uk/systemsandservices/scr/staff/faqs/mps faqs Clinical Leadership Creating the Record: Do you want a Summary Care Record? YES Do nothing and a record will be created for you NO Inform your GP Practice of your choice and no record will be created Using the Record: Can I look at your Summary Care Record? When you present for care, you will be asked* if your record can be viewed. *In an emergency where you are unable to be asked, or certain medical/legal circumstances (such as court order) the clinicians involved in your care may access the record without asking. Any such actions will be recorded for investigation.
What is the process? Local Project boards oversee process Patients written to individually 12 weeks minimum before uploads PCT runs local media awareness programme Dedicated Care Record Service information line PCT run drop in centres Events tailored for local demographic needs Practices shielded from enquiries and encouraged to refer patients to the other outlets Ease of ability to opt out universally accepted
LIVE LIVE LIVE LIVE LIVE LIVE LIVE LIVE LIVE SCR Deployment Progress Statistic Value Weekly Inc. Patients Contacted 14,381,325 2,562,718 PCTs which have PIP'd 65 8 Opt Outs* 15,681(0.63%) 358 Practices Live 208 1 Total SCR's Created 1,313,790 22,060 PCTs with Records Created 16 0 PCTs with HealthSpace 14 0 SCR Viewing Sites Technically Live 25 0 Total no of SCR clinical accesses 15,092 447 *Opt out figure reported only for those practices that have submitted data on opt out figures % GP Practices with SCR Compliant Clinical Systems Supplier Practices No. % % of Supplier Estate Deployed EMIS LV 3,582 43.13% 0.81% In Practice Systems (InPS) 1,565 18.84% 4.73% CSC/TPP 1,072 12.91% 7.74% isoft Synergy 464 5.59% 4.74% As at 12th Mar 2010 PIPs, Records Created & Viewing Deployments Bury PCT - Integrated Adastra in 4 OOH sites (BARDOC) - SCRa deployed sites: Emergency Dept./Medical Assessment Unit - low usage Hospital Pharmacy - End of Life care plans used Lambeth PCT - Integrated Adastra in OOH provider (SELDOC) x2 Rochdale, Heywood & Middleton PCT - Integrated Adastra in OOH provider (BARDOC) Bury PCT - Learning Disability Short Stay Centre (SCRa) - Mental Health usage and record enrichment (SCRa) Bolton PCT & The Royal Bolton Hospital - Integrated Adastra in OOH x 2 (NW Manchester) and WIC - SCRa deployed sites: Emergency Dept./MAU- low usage Hospital Pharmacists Early Pregnancy Unit - End of life care plans used to enrich records Bradford and Airedale PCT - Community Pharmacy (SCRa) Pennine Care Mental Health Trust - Mental Health Crisis Team using SCRa particularly in emergency situations Bolton PCT - Pre-assessment Out-patients Clinic; Dieticians; Physiotherapy (SCRa) Southwark PCT - Integrated Adastra in OOH provider (SELDOC) x2 Pennine Acute Hospital NHS Trust - Emergency Department Integrated Ascribe Symphony (April 2010) Lewisham PCT - Integrated Adastra in OOH provider (SELDOC) Stoke PCT - Diabetes care plan enrichment - Integrated Adastra in OOH (March 2010) Bexley PCT - Integrated Adastra in EAC provider (SELDOC) South Birmingham PCT - Birmingham Dental Hospital (SCRa) - Podiatry, Physiotherapy and Hospices (SCRa) South West Essex PCT - Multiple hospital department deployments at Basildon Hospital (SCRa) S.W. Ambulance Service - Integrated Adastra OOH (March 2010) Medway PCT - Integrated Adastra in OOH sites x 3 Medway PCT - End of Life care plans used to enrich records Royal Bournemouth & Christchurch Hospital NHS Foundation Trust - Emergency Department Integrated Ascribe Symphony (April 2010) Brighton and Hove PCT - Mental Health usage and record enrichment - Integrated Adastra in 1 WIC (Independent Sector Service) - OOH KEY PCT Commenced PIP PCT Commenced Record Creation Over 60% Records Created No Activity As at 12th Mar 2010
ASHTONLEIGH & WIGAN BARNET BERKSHIRE EAST BERKSHIRE WEST BEXLEY CARE TRUST BLACKBURN WITH DARWEN PCT Commenced PIP Commenced Record Creation % Records Created BOLTON 43% BOURNEMOUTH & POOLE TEACHING BRADFORD & AIREDALE TEACHING 17% BRIGHTON & HOVE CITY 5% BROMLEY BURY 72% CALDERDALE CAMBRIDGESHIRE CAMDEN CENTRAL LANCASHIRE COUNTY DURHAM DARLINGTON DORSET 39% EAST & NORTH HERTFORDSHIRE EAST LANCASHIRE TEACHING EAST SUSSEX DOWNS & WEALD EASTERN & COASTAL KENT ENFIELD GREAT YARMOUTH & WAVENEY GREENWICH TEACHING HALTON & ST.HELENS HARINGEY TEACHING HARTLEPOOL HASTINGS & ROTHER LEEDS 3% LEICESTER CITY LINCOLNSHIRE TEACHING 1% LUTON MEDWAY 37% MIDDLESBROUGH MILTON KEYNES NORFOLK 5% NORTH EAST ESSEX NORTH LANCASHIRE TEACHING PCT NORTH YORKSHIRE & YORK OLDHAM PETERBOROUGH REDCAR & CLEVELAND SEFTON SHEFFIELD SHROPSHIRE COUNTY SOMERSET 9% SOUTH BIRMINGHAM 20% SOUTH EAST ESSEX SOUTH WEST ESSEX 41% SOUTHWARK 4% STOCKTON-ON-TEES TEACHING STOKE ON TRENT 8% TELFORD & WREKIN TRAFFORD WAKEFIELD DISTRICT 30% WALSALL TEACHING WALTHAM FOREST 2% WARRINGTON WEST ESSEX WEST HERTFORDSHIRE WEST KENT WEST SUSSEX WIRRAL PIPs, Records Created & Viewing Deployments Adastra Total PDS Live SCR Live % of SCR sites Deployed HUB 66 5 4 6.06% WIC* 37 2 1 2.70% OOH* 418 17 14 3.35% EAC* 19 2 2 10.53% Ascribe Total Live % of sites Deployed Trust 38 0 0.00% Hospital Site TBC 0 0.00% *WIC - Walk In Centre *OOH - Out of Hours *EAC - Equitable Access Centre * PCTs which have commenced PIP As at 12th Mar 2010 Patient reaction I thought this happened already it s all NHS isn t it? Overall positive reaction especially for parents, older people, people who work or travel outside the PCT area Opt-outs Patient choice May genuinely not want one but may not understand People are willing to change their mind when they understand Wave 1 only 14 people opted out from 15,000 patients and opt outs continues to be very low Data loss press stories (laptops, memory sticks) People can rationalise this is not the same thing
Unscheduled Care Out of Hours and Emergency Care NOT SCR Nurse! Pass me the SCR SCR in use
Questionnaire completed by 50 clinicians in Bolton & Bury over Easter in Out of Hours 1) Did having access to your patient's SCR help inform any of your clinical decisions today? 2) Did any information on your patient's SCR about medications, allergies and adverse reactions affect any of your prescribing decisions today? Yes No Unable to access any SCR Yes No Unable to access some patient's SCR 3) What did you find to be the most useful content of the SCRs you viewed? Allergies & Adverse Reactions Repeat Medication 4) Do you believe that if today's patients had had their SCR enriched with more information, such as past medical history, it would have increased your ability to make informed clinical decisions? Discounted Repeat Medication Acute Medication No comment Yes No No comment 5) Did the information within the patient's SCR help you to better understand their problems and provide more appropriate advice? 6) Did having access to the patient's SCR make you feel more confident in treating them today? Yes No No comment Yes No No comment
SCR & HealthSpace functionality delivers clear clinical benefits End Of Life Care Long term Conditions Out of Hours District Nurse access Mobile access Mental Health Care Plans Health & Social Care Elderly Protecting Children Emergency Medicine Medicine reconciliation Personal Health Plans Patient empowerment and increasing responsibility Improving access to primary care Medicine Reconciliation NICE requirement on admission and discharge from hospital The National Patient Safety Association (NPSA) received 7070 incident reports involving medication errors at admission or discharge which resulted in 2 fatalities and 30 causing severe harm time taken to obtain information for Meds reconciliation reduced from 30-40mins to 20 seconds Brian Smith Chief Pharmacist Royal Bolton Hospital Improvements in design of SCR in 2010 requirements suggested by the hospital pharmacists
End of Life Care why is it important? High up the agenda NHS Next Stage Review DH End of Life Care Strategy Quality markers consultation National Audit Office report The wishes of people approaching the end of their life are not always conveyed to those who need to know. Such data should ideally be captured in the Summary Care Record National Audit Office, End of Life Care, Nov 08 Can SCR deliver? Yes! Why? using existing functionality of GP IT system to add end of life information, using codes & free text and facilitated by templates Thus, replacing existing paper process with electronic communication that can be seen by more healthcare professionals due to SCR What else is enabling this? Defined group of patients Clear need QOF esp 09/10 Gold Standards Framework and other initiatives
Demo end of life patient www.healthspace.nhs.uk Why has funding been found to support national PIP? At NHS request To improve surround sound and raising awareness Impossible to use media effectively practice by practice Separate information from deployment
What is HealthSpace? Patient portal through which the public have a secure online domain for their transactions with the health service 24/7 from anywhere in the world HealthSpace EA Overview People who have Basic Version 2 accounts 123,260 cumulative 2,842 new this week People who have a Basic account and live at an address which prompts the system to offer them an advanced account 9,359 cumulative 149 this week People who have taken up the offer and completed an advanced account application on-line 9,253 cumulative 149 this week People who have taken their application to a Front Office and have had that application processed successfully 2,997 cumulative 46 this week People who have fully activated their advanced account after receiving their letter from the Back Office 2,191 cumulative 19 this week
Improving the Current Service Improving the current registration process: Revising HealthSpace content on websites (including NHS CFH websites) To provide clear, updated and concise information to the patient To provide easier online access to documentation Reducing number of application rejections by strengthening Front Office process Smartcard to be added as a means of identification Improving clinician identity validation form Implementing HealthSpace Communicator
Communicator a new medium Fears of clinicians Learning from early adopters Nurses are required to make hard copy of the advice they give Telephone not always a great medium Barriers to access Asynchronous communication Access when separated by time and geography Shifts activity- replacement What else Health & Social Care impact of carer access Personal Health Plans Teenage health Mental Health
Once you have the SCR will we get the benefits? We have seen clearly in the early adopter work in secondary care the need for business change management planning The way the NHS works is various and changing it needs local championing and management The investment in change management is yielding results You already have the infrastructure: Spine, smartcards, access controls, secure patient access Summary Care Record The National Picture Dr Gillian Braunold Clinical Director SCR & HealthSpace March 2010 Gillian.braunold@nhs.net